You searched for:"Eliezer Silva"
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Guidelines for treatment of severe sepsis/septic shock: tissue perfusion assessment
Rev Bras Ter Intensiva. 2011;23(1):6-12
Abstract
Guidelines for treatment of severe sepsis/septic shock: tissue perfusion assessment
Rev Bras Ter Intensiva. 2011;23(1):6-12
DOI 10.1590/S0103-507X2011000100003
Views0See moreSepsis is a very frequent condition and causes high mortality rates and healthcare costs; it is the main cause of death in intensive care units. Clear, improved prognosis was shown for early diagnosed and treated patients. Treatment guidelines are fundamental for appropriate therapy. It is clear that hypoperfusion patients should be hemodynamically optimized; therefore, recognition of hypoperfusion signs is one of the main therapeutic steps. This guideline discusses the current literature and available data regarding the evaluation of hemodynamic parameters.
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Guidelines for the treatment of severe sepsis and septic shock: hemodynamic resuscitation
Rev Bras Ter Intensiva. 2011;23(1):13-23
Abstract
Guidelines for the treatment of severe sepsis and septic shock: hemodynamic resuscitation
Rev Bras Ter Intensiva. 2011;23(1):13-23
DOI 10.1590/S0103-507X2011000100004
Views0See moreSepsis has a high incidence, mortality and cost and is the main cause of death in intensive care units. Early recognition and treatment have been clearly associated with a better prognosis. Establishing new guidelines is a fundamental step for improving treatment. Patients with clear signs of hypoperfusion should undergo hemodynamic optimization. This guideline addresses the main strategies in the literature that are clinically available.
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Original Articles
Estimate of the economic impact of implementing an in hospital protocol for the early detection and treatment of severe sepsis in public and private hospitals in southern Brazil
Rev Bras Ter Intensiva. 2010;22(3):213-219
Abstract
Original ArticlesEstimate of the economic impact of implementing an in hospital protocol for the early detection and treatment of severe sepsis in public and private hospitals in southern Brazil
Rev Bras Ter Intensiva. 2010;22(3):213-219
DOI 10.1590/S0103-507X2010000300001
Views0See moreOBJECTIVE: To analyze the economic impact of an early sepsis detection protocol in two general hospitals. METHODS: We analyzed data collected from a prospective study of septic patients before and after the implementation of a protocol for early diagnosis of severe sepsis. We conducted a cost-effectiveness analysis comparing: mortality rate, cost of sepsis treatment and indirect costs attributed to years of productive life lost to premature death in both phases. RESULTS: Two hundred seventeen patients were included, 102 in phase I and 115 in phase II. After protocol implementation, in private and public hospital, mortality rates decreased from 50% to 32.2% and from 67.6% to 41% (p < 0.05). The mean years of productive life lost due to sepsis decreased from 3.18 to 0.80 and 9.81 to 4.65 (p < 0.05), with a mean gain of 2.38 and 5.16 years of productive life, for each septic patient. Considering Brazilian gross domestic product per capita, estimated productivity loss due to sepsis decreased between 3.2 and 9.7 billion US dollars, varying based on the incidence of sepsis. Hospital costs were similar in both phases. CONCLUSION: A protocol for early detection and treatment of in-hospital septic patients is highly cost-effective from a societal perspective.
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Original Articles
Outcomes of cancer patients admitted to Brazilian intensive care units with severe acute kidney injury
Rev Bras Ter Intensiva. 2010;22(3):236-244
Abstract
Original ArticlesOutcomes of cancer patients admitted to Brazilian intensive care units with severe acute kidney injury
Rev Bras Ter Intensiva. 2010;22(3):236-244
DOI 10.1590/S0103-507X2010000300004
Views0See moreOBJECTIVES: Critically ill cancer patients are at increased risk for acute kidney injury, but studies on these patients are scarce and were all single centered conducted in specialized intensive care units. The objective was to evaluate the characteristics and outcomes in a prospective cohort of cancer patients admitted to several intensive care units with acute kidney injury. METHODS: Prospective multicenter cohort study conducted in intensive care units from 28 hospitals in Brazil over a two-month period. Univariate and multivariate logistic regression were used to identify factors associated with hospital mortality. RESULTS: Out of all 717 intensive care unit admissions, 87 (12%) had acute kidney injury and 36% of them received renal replacement therapy. Kidney injury developed more frequently in patients with hematological malignancies than in patients with solid tumors (26% vs. 11%, P=0.003). Ischemia/shock (76%) and sepsis (67%) were the main contributing factor for and kidney injury was multifactorial in 79% of the patients. Hospital mortality was 71%. General and renal-specific severity-of-illness scores were inaccurate in predicting outcomes for these patients. In a multivariate analysis, length of hospital stay prior to intensive care unit, acute organ dysfunctions, need for mechanical ventilation and a poor performance status were associated with increased mortality. Moreover, cancer-related characteristics were not associated with outcomes. CONCLUSIONS: The present study demonstrates that intensive care units admission and advanced life-support should be considered in selected critically ill cancer patients with kidney injury.
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Consenso Brasileiro de Monitorização e Suporte Hemodinâmico
Part II: basic hemodynamic monitoring and the use of pulmonary artery catheter
Rev Bras Ter Intensiva. 2006;18(1):63-77
Abstract
Consenso Brasileiro de Monitorização e Suporte HemodinâmicoPart II: basic hemodynamic monitoring and the use of pulmonary artery catheter
Rev Bras Ter Intensiva. 2006;18(1):63-77
DOI 10.1590/S0103-507X2006000100012
Views1See moreBACKGROUND AND OBJECTIVES: Monitoring of vital functions is one of the most important tools in the management of critically ill patients. Nowadays is possible to detect and analyze a great deal of physiologic data using a lot of invasive and non-invasive methods. The intensivist must be able to select and carry out the most appropriate monitoring technique according to the patient requirements and taking into account the benefit/risk ratio. Despite the fast development of non invasive monitoring techniques, invasive hemodynamic monitoring using Pulmonary Artery Catheter still is one of the basic procedures in Critical Care. The aim was to define recommendations about clinical utility of basic hemodynamic monitoring methods and the Use of Pulmonary Artery Catheter. METHODS: Modified Delphi methodology was used to create and quantify the consensus between the participants. AMIB indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the Consensus Advisory Board. Twenty-five physicians and nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the MEDLINE in the period from 1996 to 2004. RESULTS: Recommendations were made based on 55 questions about the use of central venous pressure, invasive arterial pressure, pulmonary artery catheter and its indications in different settings. CONCLUSIONS: Evaluation of central venous pressure and invasive arterial pressure, besides variables obtained by the PAC allow the understanding of cardiovascular physiology that is of great value to the care of critically ill patients. However, the correct use of these tools is fundamental to achieve the benefits due to its use.
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Consenso Brasileiro de Monitorização e Suporte Hemodinâmico
Brazilian consensus of monitoring and hemodynamic support – part III: alternative methods for cardiac output monitoring and volemia estimation
Rev Bras Ter Intensiva. 2006;18(1):78-85
Abstract
Consenso Brasileiro de Monitorização e Suporte HemodinâmicoBrazilian consensus of monitoring and hemodynamic support – part III: alternative methods for cardiac output monitoring and volemia estimation
Rev Bras Ter Intensiva. 2006;18(1):78-85
DOI 10.1590/S0103-507X2006000100013
Views0See moreBACKGROUND AND OBJECTIVES: Cardiac output and preload as absolute data do not offer helpful information about the hemodynamic of critically ill patients. However, monitoring the response of these variables to volume challenge or inotropic drugs is a very useful tool in the critical care setting, particularly for patients with signs of tissue hypoperfusion. Although PAC remains the ” gold standard” to measure cardiac output and preload, new and alternative technologies were developed to evaluate these hemodynamic variables. METHODS: Modified Delphi methodology was used to create and quantify the consensus between the participants. AMIB indicated a coordinator who invited more six experts in the area of monitoring and hemodynamic support to constitute the Consensus Advisory Board. Twenty three physician and two nurses selected from different regions of the country completed the expert panel, which reviewed the pertinent bibliography listed at the MEDLINE in the period from 1996 to 2004. RESULTS: Recommendations regarding the use of arterial pulse pressure variation during mechanical ventilation, continuous arterial pulse contour and lithium dilution cardiac output measurements, esophageal Doppler waveform, thoracic electrical bioimpedance, echocardiography and partial CO2 rebreathing for monitoring cardiac output and preload were created. CONCLUSIONS: The new and less invasive techniques for the measurement of cardiac output, preload or fluid responsiveness are accurate and may be an alternative to PAC in critically ill patients.
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Editorial
Sepsis, a problem with the size of Brazil
Rev Bras Ter Intensiva. 2006;18(1):5-6
Abstract
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Comentários
Surviving sepsis campaign: um esforço mundial para mudar a trajetória da sepse grave
Rev Bras Ter Intensiva. 2006;18(4):325-327
Abstract
ComentáriosSurviving sepsis campaign: um esforço mundial para mudar a trajetória da sepse grave
Rev Bras Ter Intensiva. 2006;18(4):325-327
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness Extracorporeal membrane oxygenation Infant, newborn Intensive care Intensive care units Intensive care units, pediatric mechanical ventilation Mortality Physical therapy modalities Prognosis Respiration, artificial Respiratory insufficiency risk factors SARS-CoV-2 Sepsis